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Last Modified: 4/13/2018 Location: FL, PR, USVI Business: Part A, Part B

Provider inquiry checklist

Be prepared when contacting First Coast Service Options Inc. (First Coast)

In accordance with the Health Insurance Portability & Accountability Act (HIPAA), First Coast is entrusted to secure protected health information (PHI) of all individuals. Access to patient and claims information requires an authentication process.
Use the following checklist to ensure you have the authentication information required (right column) for the specific type of inquiry indicated (left column). Separate checklists have been provided for inquiries performed through our Interactive Voice Response (IVR) system and for those made through our provider contact center, whether in Florida (FL), Puerto Rico (PR), or the U.S. Virgin Islands (USVI).

IVR Inquiries

Part A (FL, PR, USVI) -- 1-877-602-8816

Part B (FL, PR, USVI) -- 1-877-847-4992

IVR Inquiry type

Information required

For all inquiries identified below, the National Provider Identifier (NPI), Provider Transaction Access Number (PTAN) and the last 5 digits of the Provider’s Tax Identification Number (TIN) are required.
Claim status
Patient’s last name -- first 6 letters
Patient’s first initial
Patient’s Medicare ID
Date of service (DOS)
Clerical reopening (claim adjustment) -- single line (Part B only) Click here for additional details
Change date(s) of service (DOS) and quantity billed (if desired)
Add, change, delete modifier(s) (Exceptions: modifiers 21, 22, 24, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, SG, or WU)
Note: Application of GV or GW modifiers (hospice) can be applied to an entire claim
Change diagnosis code
Change procedure code and billed amount (if desired)
Change quantity billed and billed amount (if desired)
Change ordering or referring provider information
Entitlement reopenings (History corrections)
Change in entitlement effective dates
Update regarding patient’s primary insurance -- Medicare secondary payer (MSP) situations
Medicare Advantage (MA) plan involvement update
Update to patients records
Caller’s name
Caller’s 10-digit telephone number
Patient’s Medicare ID
Patient’s first initial
Patient’s last name -- first 6 letters
Patient’s date of birth (DOB)
Internal Control Number (ICN) of claim requested
Date of service (DOS)
Item(s) or service(s) at issue
New or revised information
Patient’s eligibility
Patient’s last name -- first 6 letters
Patient’s first initial
Patient’s Medicare ID
Patient’s date of birth (DOB)
Provider enrollment application status
Click here to look up your enrollment status
Correspondence Control Number (CCN) -- 15 digits

Provider Contact Center

Part A: FL, USVI -- 1-888-664-4112 PR -- 1-877-908-8433

Part B: FL, USVI -- 1-866-454-9007 PR -- 1-877-715-1921

Customer service inquiry type

Information required

For all inquiries identified below, the NPI, PTAN and the last 5 digits of the Provider’s Tax Identification Number (TIN) are required.
Appeals request -- status
Patient’s last name
Patient’s first name or initial
Patient’s Medicare ID
Claim information (excluding status)
Clerical reopening -- (Part B only)
Speak to CSR for reopening previously adjusted claims.
Note: Reopenings cannot be performed on:
Pending claims
Non-assigned claims
Certain drug and drug administration codes
Requests related to modifiers 21, 22, 24, 51, 52, 53, 56, 62, 66, 99, CC, GA, GY, GZ, SG, or WU
For claim types listed above, consider a redetermination.
Patient’s Medicare ID
Patient’s last name
Patient’s first name/initial
Patient’s date of birth (DOB)
Date of service (DOS)
Item(s) or service(s) at issue
New/revised information
Clerical reopening -- (Part B only)
CSRs may only assist on certain claims that are not able to be reopened via the IVR.
Patient’s last name
Patient’s first name/initial
Patient’s Medicare ID
Date of service (DOS)
Item(s) or service(s) at issue
New/revised information
Patient’s eligibility issue (if not available through IVR)
Patient’s last name
Patient’s first name/initial
Patient’s Medicare ID
Patient’s date of birth (DOB)
Provider enrollment issue** (excluding status)
**Only contact person on application may call to discuss issue.
Click here to look up your enrollment status
Correspondence Control Number (CCN) -- 15 digits
Copy of application and any correspondence sent
Source: CMS IOM Pub. 100-09, Chapter 6, Section 80.1 and 80.2.1
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.